Parathyroidectomy in the elderly population: Does age really matter?

Abstract

Nearly 700 parathyroidectomies were performed at our institution over 10 years. Elderly patients comprised one third of this population. They were likely to have longer hospital and recovery room stays, and postoperative normocalcemia with elevated PTH, which may actually be a normal finding for these patients, but it warrants further study. The rate, timing, and types of complications were similar between age groups, although elderly patients had more cardiac complications. When properly indicated, parathyroidectomy remains a safe and effective option for management of hyperparathyroidism in elderly patients.

Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism

“…Program Study" found no difference in post-surgical complications between patients >80 years and those <60 years (25). Similarly, another study reported comparable complication rates for ≥65-year old patients undergoing parathyroidectomy when compared to younger ones (21). A more previous study also underlines our findings by reporting similar rates for surgical re-explorations and postoperative complications between <70-year-old patients and patients ≥70 years (19).…”

“…Previous studies have reported conflicting findings concerning PTX-safety in elderly patients (16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Parathyroid Surgery in the Elderly

“…Generally, patients who undergo PTx by either strategy are hospitalized for between 4 and 24 hours postoperatively with patients undergoing BNE more frequently admitted for an overnight observation. Multiple studies have found that elderly patients have significantly longer post-PTx hospitalizations compared with younger patients, although lengths of stay were not clearly defined by type of operation (BNE versus MIP) [52, 53]. Although two studies reported that same-day discharge is half as likely in elderly versus younger patients at the same institutions [52, 53], other studies found no difference [9, 14, 43].…”

“…Multiple studies have found that elderly patients have significantly longer post-PTx hospitalizations compared with younger patients, although lengths of stay were not clearly defined by type of operation (BNE versus MIP) [52, 53]. Although two studies reported that same-day discharge is half as likely in elderly versus younger patients at the same institutions [52, 53], other studies found no difference [9, 14, 43]. Recent shortened lengths of stay in all patients have been attributed to the introduction of minimally invasive techniques [50, 52].…”

“…Transient hypocalcemia is the most common complication of PTx, followed by infection and hoarseness from temporary recurrent laryngeal nerve injury. One report found that elderly patients are significantly more likely to experience cardiac complications than younger patients (2.8% versus 0.5%, p = 0.022), although this is rare even in elderly patients [53]. Mortality is uncommon after PTx, approaching 1% in some large studies of elderly patients undergoing PTx, and typically can be attributed to significant to comorbid conditions [25, 44, 24, 53].…”